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Anorexia Nervosa

Anorexia nervosa is a severe and potentially life-threatening mental health condition where an individual becomes excessively focused on their body weight and has an intense fear of gaining weight, often resembling a phobia. The person with anorexia will try to achieve an extremely low weight through self-imposed starvation and extreme weight loss.

Individuals with anorexia nervosa typically exhibit:

  • Continuous limitation of food intake resulting in a body weight that is significantly lower than what is considered normal for a person's age, sex, developmental stage, and overall physical health.
  • An intense fear of gaining weight or becoming fat, or engaging in behaviors that prevent weight gain despite being significantly underweight.
  • A distorted perception of one's body weight or shape, where body image heavily influences self-esteem, or a persistent inability to recognize the severity of the current low body weight.

How Anorexia May Affect You (Symptoms)

  • Consistently consuming fewer calories than recommended, resulting in significant or rapid weight loss.
  • Becoming preoccupied with calories, food, and anything related to eating.
  • Experiencing an intense fear of gaining weight and going to great lengths to prevent it.
  • Having a distorted and negative body image.
  • Struggling with extremely low self-esteem.
  • Feeling unable to recognize the seriousness of the condition or feeling powerless to change it.

Things to look out for (Warning Signs)

  • Significant weight loss.
  • Obsession with dieting, fasting, or using extreme methods to lose weight.
  • Refusal to eat certain foods or entire food groups (e.g., avoiding carbohydrates, dairy, or suddenly adopting a vegan diet).
  • Distress about being "fat" or overweight despite being underweight.
  • Intense fear of gaining weight or becoming "fat."
  • Denial of hunger.
  • Development of specific food rituals (e.g., eating foods in a particular order, excessive chewing, or rearranging food on a plate).
  • Making consistent excuses to avoid meals or situations involving food.
  • An excessive, rigid exercise routine—continuing regardless of weather, fatigue, illness, or injury, driven by the need to "burn off" calories consumed.
  • Withdrawing from friends and usual activities.
  • General behaviors and attitudes suggesting that weight loss, dieting, and control over food have become the primary focus.

Consequences and Complications:

  • Slow heart rate and low blood pressure, leading to changes in the heart muscle. As heart rate and blood pressure continue to drop, the risk of heart failure increases.
  • Gastrointestinal issues, including constipation and bloating.
  • Hormonal imbalances, including the loss of menstruation and regression of ovaries and testes.
  • Weakened immunity and anemia.
  • Decreased bone density (osteoporosis), resulting in dry and fragile bones.
  • Muscle loss and weakness.
  • Severe dehydration, which can lead to kidney failure.
  • Fainting, fatigue, and general weakness.
  • Dry hair and skin, with hair loss being common.
  • Growth of fine, soft hair known as lanugo across the body, including the face, as the body attempts to stay warm.
  • Intense depression.

Bulimia Nervosa 

Bulimia Nervosa is a severe and potentially life-threatening eating disorder characterized by a recurring cycle of binge eating followed by compensatory behaviors, such as self-induced vomiting, intended to counteract the effects of overeating.

Diagnosis Criteria

As per the DSM-5 guidelines, to be diagnosed with Bulimia Nervosa, an individual must exhibit:

 

Recurrent binge eating episodes, defined by both of the following:

  1. Eating a significantly larger amount of food than most people would in a similar timeframe (e.g., within a 2-hour period), and under comparable circumstances.
  2. A feeling of loss of control during the episode, such as an inability to stop eating or regulate the type or quantity of food consumed.
  • A feeling of being unable to control eating during the episode, such as not being able to stop eating or regulate what or how much is consumed
  • Recurrent inappropriate compensatory behaviors intended to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, other medications, fasting, or excessive exercise.
  • Both binge eating and compensatory behaviors occur, on average, at least once a week for three months.
  • Self-worth is excessively influenced by body shape and weight.
  • The disturbance does not occur solely during episodes of Anorexia Nervosa.

Warning Signs to Look Out For:

  • Evidence of binge eating, such as large amounts of food disappearing in a short time. You may find food wrappers or containers that suggest food was consumed in secret.
  • Signs of purging behaviors, like frequent trips to the bathroom after meals, smells or signs of vomiting, or the discovery of laxatives or diuretics.
  • Extreme and rigid exercise routines, regardless of weather, fatigue, illness, or injury, driven by the need to “burn off” calories consumed during a binge.
  • Bloodshot eyes, as frequent vomiting can cause small blood vessel ruptures in the eyes.
  • Swelling in the cheeks or jaw area.
  • Calluses on the backs of hands or knuckles from self-induced vomiting.
  • Discoloration or staining of the teeth.
  • The creation of strict schedules or rituals to accommodate binge-and-purge cycles.
  • Withdrawal from usual social activities and friends.
  • Behaviors and attitudes suggesting that weight loss, dieting, and control over food are becoming the main focus.
  • Frequent fluctuations in weight.

How Bulimia May Affect You (Symptoms)

  • A strong urge to eat, regardless of hunger or fullness, continuing until the binge feels "complete" — at times, this can feel like waking from a trance.
  • A sense of losing control during binge-eating episodes, feeling compelled to continue until the episode ends.
  • Self-esteem and self-worth are tightly connected to your body and body image issues, with feelings of being or feeling "fat" dominating your emotions.
  • A complete denial of feelings before a bulimic episode, followed by an overwhelming wave of negative emotions such as shame, disgust, anger, and depression afterward.
  • A powerful urge to expel the feelings (through vomiting or purging), as well as the food consumed during a binge, in an attempt to feel empty both physically and emotionally.
  • Bulimia may become a "secret" companion, always present when needed. While this attachment may feel comforting, it can also leave you feeling isolated and alone with your struggles.

Consequences and Complications

 

Bulimia nervosa can take a severe toll on the body. The cycle of binge eating and purging can severely impact the digestive system, while purging behaviors can cause electrolyte and chemical imbalances, affecting the heart and other vital organs. Some of the complications associated with bulimic behaviors include:

  • Retinal displacement: The intense pressure from vomiting can often result in bloodshot eyes, a common side effect. In rare cases, the damage can be so severe that surgery is required to correct it.
  • Electrolyte imbalances: These imbalances, caused by dehydration and the loss of potassium and sodium due to purging, can lead to irregular heart rhythms and, in extreme cases, heart failure or death.
  • Oesophageal inflammation or rupture: Frequent vomiting can cause severe inflammation and, in some cases, rupture of the esophagus.
  • Oesophageal cancer: Patients hospitalised previously with eating disorders are at increased risk of developing oesophageal cancer.
  • Tooth decay and enamel erosion: Stomach acids released during vomiting can damage teeth, leading to decay and staining.
  • Chronic constipation and irregular bowel movements: These issues are often exacerbated by the use of laxatives.
  • Gastric rupture: Though rare, gastric rupture can occur in extreme cases.

BINGE EATING DISORDER 

Binge Eating Disorder is less common but far more severe than general overeating. It is often associated with greater emotional distress related to eating behaviors, and frequently co-occurs with other psychological issues.

Diagnosis Criteria

As outlined by the DSM-5, to be diagnosed with Binge Eating Disorder, a person must exhibit:

  • Recurrent binge eating episodes, characterized by both of the following:
    1. Consuming an amount of food during a specific time period (e.g., within 2 hours) that is significantly larger than what most people would eat in similar circumstances.
    2. Experiencing a lack of control over eating during the episode, such as feeling unable to stop eating or control how much or what is being eaten.

Binge Eating Episodes are Associated with Three or More of the Following:

  • Eating much more quickly than usual.
  • Eating until feeling uncomfortably full.
  • Consuming large amounts of food even when not physically hungry.
  • Eating in private due to embarrassment about the quantity consumed.
  • Feeling disgusted with oneself, depressed, or overwhelmingly guilty afterward.
  • Marked distress related to binge eating.
  • Binge eating occurring at least once a week on average for three months.
  • Binge eating not associated with the repeated use of compensatory behaviors (such as self-induced vomiting) like in Bulimia Nervosa, and not occurring exclusively during episodes of Bulimia Nervosa or Anorexia Nervosa.

How You May Experience Binge Eating Disorder (Symptoms)

  • A compulsion to eat regardless of hunger or fullness, continuing until the binge feels "complete," sometimes feeling as though you're waking from a trance-like state.
  • A sense of losing control during binge episodes, feeling unable to stop until it naturally ends.
  • Self-esteem and self-worth being heavily tied to body image issues, with constant feelings of being or feeling "fat."
  • Unlike Bulimia and Anorexia, there are no compensatory behaviors such as vomiting, restricting, overeating, or excessive exercise.
  • Stockpiling and hiding food to eat later in private.
  • A tendency to eat late at night.
  • Becoming preoccupied with food, eating, and the anticipation of binge episodes, making it the central focus of your thoughts.

Potential Signs of Binge Eating Disorder:

  • Evidence of binge eating, such as large amounts of food disappearing quickly or finding food wrappers and containers indicating food may have been consumed secretly.
  • Feelings of guilt, shame, and anger surrounding eating habits.
  • Developing routines or rituals specifically to make time for binge eating episodes.
  • Withdrawing from regular social activities and relationships.
  • A constant preoccupation with controlling weight and eating habits, often coupled with a strong belief in the need to diet.
  • A sense of helplessness regarding weight gain.
  • Health-related consequences (e.g., diabetes).

Consequences and Complications

 

The unhealthy eating patterns associated with binge eating disorder can lead to significant health issues. The primary complications often arise from obesity, which is common among those with this disorder.

These include:

  • Diabetes
  • High blood pressure
  • Elevated cholesterol levels
  • Gallbladder disease
  • Heart disease
  • Shortness of breath
  • Certain types of cancer
  • Menstrual irregularities
  • Reduced mobility and fatigue
  • Sleep disorders, including sleep apnea

Disordered Eating

Disordered Eating refers to a broad range of irregular eating behaviors that can also be part of the criteria for diagnosing an eating disorder.

What sets an eating disorder apart from disordered eating is the intensity and frequency of these behaviors. For example, someone might occasionally binge, purge, use laxatives or diet pills, or skip meals, but not to the extent that it meets the criteria for a full eating disorder diagnosis.

These behaviors are common and often arise after stressful life events or illness. For most individuals, these behaviors are temporary, and they return to normal eating patterns over time.

It’s important to recognize when disordered eating may be escalating into a full eating disorder. If these behaviors are affecting daily life, relationships, or other aspects of well-being, it’s recommended to consult with your GP for guidance or reach out to us.

 

As always, early intervention is crucial to prevent these behaviors and thought patterns from becoming deeply ingrained.

Our relationship with food may not be recognised as a clinically diagnosable eating disorder, however you or others may be concerned by unhealthy behaviours around food. It is important to recognise that often these behaviours can be precursors to eating disorders and should be taken seriously.

Please consult your GP if you are concerned about any of the following:

 

An all-consuming dieting mindset, which could include restricting, skipping meals, obsessive calories counting, avoiding certain food groups. This might also see someone taking laxatives, diet pills or diuretics, and over-exercising.

An obsession with ‘clean/healthy eating’ – otherwise informally known as ‘Orthorexia’, whereby an individual might avoid certain foods or whole groups of foods that are believed to be unhealthy. Examples could be cutting out fats or carbohydrates and perhaps a reliance on supplements, protein powders and faddy foods.

 

Additionally someone with Orthorexia may demonstrate other obsessive behaviours such as over or extreme exercising

Emotional overeating – Eating in response to state of mind, rather than hunger.

Compulsive overeating – Could be known or experienced as a lesser form of Binge eating disorder.

An inability to maintain a healthy relationship with food, regardless of health concerns or complications. This can be, but not exclusively, a behaviour designed to manage emotional states.

OFSED
Other Specified Feeding or Eating Disorders

Criteria for Diagnosis

To be diagnosed with OSFED (Other Specified Feeding or Eating Disorder), a person must exhibit feeding and/or eating behaviors that cause significant distress and interfere with daily functioning, but do not fully meet the criteria for any other specific feeding or eating disorder.

Examples of eating or feeding disorders that may fall under the OSFED category include:

  • Night Eating Syndrome: Recurrent, distressing episodes of eating late at night or during the night after waking.
  • PICA: Ongoing consumption of non-nutritive substances such as ice, cotton wool, or sawdust, where this behavior is not a culturally accepted practice. Pica often occurs during pregnancy (but typically resolves) and is associated with certain mental health conditions.
  • Rumination Disorder: Repeated regurgitation of food that may be re-chewed, re-swallowed, or spit out. This behavior is not related to any medical conditions like gastrointestinal issues and may be linked to other mental health disorders.
  • ARFID (Avoidant/Restrictive Food Intake Disorder): Previously known as Selective Eating Disorder (SED), where food intake is limited due to its appearance, taste, smell, or texture, often resulting from a past negative experience with a specific food.
  • Atypical Forms of Anorexia Nervosa and Bulimia Nervosa: These include cases where behaviors are less frequent or where BMI is maintained within a normal range but other symptoms of anorexia or bulimia are present.

These disorders may either exist as standalone eating disorders or coexist with other mental health conditions. If you believe your issue doesn't fit neatly into any specific diagnosis, it’s crucial to speak with your GP as soon as possible. Essex Eating Disorder Services offers confidential counselling for OSFED to help you restore a balanced and healthy relationship with food.

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